| NPI | 1376932798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB DRIGGERS COO 843-818-5437 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 4476) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 4209) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2015-01-22 |